The Narrow Lumbar Spinal Canal or Lumbar Spinal Stenosis

Background: Lumbar spinal stenosis often associates with chronic pain described the abnormal narrowing of the lumbar spinal canal, resulting in compression of neural elements within the central spinal canal or the lateral recesses or the root canals or coordinate with each other. The purpose of this study was to describe and compare the plain X-ray and magnetic resonance imaging features of lumbar canal stenosis. Materials and methods: This was a cross-sectional study of 78 patients with an acquired lumbar spinal canal between October 2017 and May 2018. Results: The X-rays confirmed osteophytes in 92.3%, endplate sclerosis in 88.5% and disc space narrowing 62.8%. On MRI, 213 lumbar levels were lumbar spinal canal stenosis, 181 lumbar levels were evaluated for the grade of central spinal canal stenosis. Conclusions: X-ray examination has limitations in a diagnosis of lumbar spinal stenosis but also serves as a diagnostic aid. MRI is well diagnosed as spinal pathology as well as lumbar spinal stenosis. Key words: Lumbar spinal, Lumbar spinal stenosis, Magnetic resonance imaging (MRI), X-ray, Grading

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“Slalom”: Microsurgical Cross-Over Decompression for Multilevel Degenerative Lumbar Stenosis

BioMed Research International ◽

10.1155/2016/9074257 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 8

Author(s):

H. Michael Mayer ◽

Franziska Heider

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Spinal Canal ◽

Facet Joint ◽

Leg Pain ◽

Degenerative Lumbar Spinal Stenosis ◽

Canal Stenosis ◽

Microsurgical Decompression ◽

Lumbar Spinal Canal ◽

Lumbar Spinal

Objective.Selective, bilateral multisegmental microsurgical decompression of lumbar spinal canal stenosis through separate, alternating cross-over approaches.Indications. Two-segmental and multisegmental degenerative central and lateral lumbar spinal stenosis.Contraindications. None.Surgical Technique.Minimally invasive, muscle, and facet joint-sparing bilateral decompression of the lumbar spinal canal through 2 or more alternating microsurgical cross-over approaches from one side.Results.From December 2010 until December 2015 we operated on 202 patients with 2 or multisegmental stenosis (115 f; 87 m; average age 69.3 yrs, range 51–91 yrs). All patients were suffering from symptoms typical of a degenerative lumbar spinal stenosis. All patients complained about back pain; however the leg symptoms were dominant in all cases. Per decompressed segment, the average OR time was 36 min and the blood loss 45.7 cc. Patients were mobilized 6 hrs postop and hospitalization averaged 5.9 days. A total of 116/202 patients did not need submuscular drainage. 27/202 patients suffered from a complication (13.4%). Dural tears occurred in 3.5%, an epidural hematoma in 5.5%, a deep wound infection in 1.98%, and a temporary radiculopathy postop in 1.5%. Postop follow-up ranged from 12 to 24 months. There was a significant improvement of EQ 5 D, Oswestry Disability Index (ODI), VAS for Back and Leg Pain, and preoperative standing times and walking distances.

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Percutaneous endoscopic transforaminal lumbar spinal canal decompression for lumbar spinal stenosis

Medicine ◽

10.1097/md.0000000000005186 ◽

2016 ◽

Vol 95 (50) ◽

pp. e5186 ◽

Cited By ~ 18

Author(s):

Bingtao Wen ◽

Xifeng Zhang ◽

Lin Zhang ◽

Peng Huang ◽

Guoquan Zheng

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Spinal Canal ◽

Lumbar Spinal Canal ◽

Lumbar Spinal

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Spinal canal diameter in degenerative lumbar spinal stenosis

Journal of Anatomical Society of India ◽

10.1016/j.jasi.2018.07.005 ◽

2018 ◽

Vol 67 ◽

pp. S25-S28 ◽

Cited By ~ 1

Author(s):

R. Sethi ◽

V. Singh

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Spinal Canal ◽

Degenerative Lumbar Spinal Stenosis ◽

Canal Diameter ◽

Lumbar Spinal

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Intraoperative Myelography in Transpsoas Lateral Lumbar Interbody Fusion for Degenerative Lumbar Spinal Stenosis: A Preliminary Prospective Study

BioMed Research International ◽

10.1155/2017/3742182 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Yang Yang ◽

Liangming Zhang ◽

Jianwen Dong ◽

Zihao Chen ◽

Peigen Xie ◽

...

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Spinal Canal ◽

Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Degenerative Lumbar Spinal Stenosis ◽

Lateral Lumbar Interbody Fusion ◽

Radiological Parameters ◽

One Year ◽

Lumbar Spinal

Aim. To investigate the feasibility and effectiveness of intraoperative myelography in determining adequacy of indirect spinal canal decompression during transpsoas lateral lumbar interbody fusion (LLIF). Methods. Seven patients diagnosed with degenerative lumbar spinal stenosis (DLSS) were prospectively included to this study. All patients underwent LLIF and subsequently received intraoperative myelography to determine the effect of indirect spinal canal decompression, which was visualized in both anterior-posterior and lateral images. Those patients with insufficient indirect canal decompression were further resolved by microendoscopic canal decompression (MECD). Radiological parameters, including stenosis ratio and dural sac area of operated levels, were measured and compared before and after operation. Besides, all patients were followed up for at least one year using visual analogue scale (VAS) for back and leg, Japanese Orthopaedic Association score (JOA), and Oswestry disability index (ODI). Results. Seven patients with 8 operated levels underwent LLIF safely and demonstrated significant symptom relief postoperatively. Five operated levels showed adequate indirect canal decompression intraoperatively, while the remaining three levels did not achieve the adequacy, and their residual stenosis was resolved following MECD. Radiological parameters were improved statistically when compared with preoperation (P<0.05). Furthermore, neurological symptoms of all patients were also improved significantly (P<0.05), shown by improved VAS (back and leg), JOA, and ODI at both two-week and one-year follow-up. Conclusions. Intraoperative myelography during LLIF is able to assess adequacy of indirect canal decompression for DLSS, thus promising favorable clinical outcomes.

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Comparative Study Between Uniportal Full-Endoscopic Interlaminar and Tubular Approach in the Treatment of Lumbar Spinal Stenosis: A Pilot Study

Global Spine Journal ◽

10.1177/2192568219878419 ◽

2020 ◽

Vol 10 (2_suppl) ◽

pp. 70S-78S

Author(s):

Angela Carrascosa-Granada ◽

Willian Velazquez ◽

Ralf Wagner ◽

Anwar Saab Mazzei ◽

Andrés Vargas-Jimenez ◽

...

Keyword(s):

Clinical Improvement ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Spinal Canal ◽

Endoscopic Approach ◽

Endoscopic Technique ◽

Dural Sac ◽

Lumbar Spinal ◽

Endoscopic Group

Study Design: Multicenter, prospective, randomized, and double-blinded study. Objectives: To compare tubular and endoscopic interlaminar approach. Methods: Patients with lumbar spinal stenosis and neurogenic claudication of were randomized to tubular or endoscopic technique. Enrollment period was 12 months. Clinical follow up at 1, 3, 6 months after surgery with visual analogue scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association (JOA) score. Radiologic evaluation with magnetic resonance pre- and postsurgery. Results: Twenty patients were enrolled: 10 in tubular approach (12 levels) and 10 in endoscopic approach (11 levels). The percentage of enlargement of the spinal canal was higher in endoscopic approach (202%) compared with tubular approach (189%) but was not statistically significant ( P = .777). The enlargement of the dural sac was higher in endoscopic group (209%) compared with tubular group (203%) but no difference was found between the 2 groups ( P = .628). A modest significant correlation was found between the percentage of spinal canal decompression and enlargement of the dural sac ( r = 0.5, P = .023). Both groups reported a significant clinical improvement postsurgery. However, no significant association was found between the percentage of enlargement of the spinal canal or the dural sac and clinical improvement as determined by scales scores. Endoscopic group had lower intrasurgical bleeding ( P < .001) and lower disability at 6 months of follow-up than tubular group (p=0.037). Conclusions: In the treatment of lumbar spinal stenosis, endoscopic technique allows similar decompression of the spinal canal and the dural sac, lower intrasurgical bleeding, similar symptoms improvement, and lower disability at 6 months of follow-up, as compared with the tubular technique.

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Kinematic effects of a pedicle-lengthening osteotomy for the treatment of lumbar spinal stenosis

Journal of Neurosurgery Spine ◽

10.3171/2012.6.spine11518 ◽

2012 ◽

Vol 17 (4) ◽

pp. 314-320 ◽

Cited By ~ 13

Author(s):

Ali Kiapour ◽

D. Greg Anderson ◽

David B. Spenciner ◽

Lisa Ferrara ◽

Vijay K. Goel

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Spinal Canal ◽

Neural Foramen ◽

Cross Sectional ◽

Kinematic Behavior ◽

Lengthening Osteotomy ◽

Spine Model ◽

The Cross ◽

Lumbar Spinal

Object Lumbar spinal stenosis (LSS) may lead to disabling neurogenic symptoms and has traditionally been treated using open laminectomy. A new technique for correcting LSS involves lengthening the lumbar pedicles through bilateral percutaneous pedicle osteotomies. In this paper, the authors' goal was to evaluate the changes in spinal canal dimensions and kinematic behavior after pedicle-lengthening osteotomies. Methods The kinematic behavior of 8 cadaveric lumbar segments was evaluated intact and after bilateral pedicle-lengthening osteotomies at the L-4, L-5, and L-4 and L-5 levels. Testing was conducted with and without a compressive preload using a custom kinematic apparatus that allowed for 3D tracking of each vertebra during flexion-extension, right-left bending, and right-left rotation. A validated finite element (FE) spine model was used to measure the changes in the cross-sectional area of the spinal canal and neural foramen after 2-, 3-, and 4.5-mm simulated pedicle-lengthening osteotomy procedures. Results The overall and segmental kinematics were not significantly altered after the pedicle-lengthening osteotomy procedure at the L-4 and/or L-5 pedicles. The kinematic signatures of the intact and lengthened states were similar for all motion pairs. The FE spine model yielded kinematics predictions within or close to the 95% confidence interval for the cadaveric data. The FE spine demonstrated substantial, pedicle length–dependent enlargement of the cross-sectional areas of the spinal canal and neural foramen after simulated pedicle lengthening. Conclusions Bilateral pedicle-lengthening osteotomies produced substantial increases in the cross-sectional areas of the spinal canal and neural foramen without significantly altering normal spinal kinematics. This technique deserves further study as a less invasive treatment option for LSS.

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